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Inspection carried out on 10 January 2018

During a routine inspection

Fair View Lodge is operated by Peninsula Autism Services & Support Limited, and is registered as a care home without nursing to provide accommodation to three people living with autistic spectrum disorders or learning disabilities. Each person has their own flat within the building and people can choose to spend time together or apart as they wish, using some shared facilities.

This inspection took place on 10 January 2018 and was announced. The service was given short notice of the inspection (24 Hours). This was to ensure someone was available to support us with the inspection, and to ensure people living at the service were aware in advance people were visiting.

We had previously inspected the service on 25 November 2015, when the service was rated as good in all areas. We found this good practice had been sustained. The service had demonstrated continuous improvement since this inspection in 2015 and we have rated them as Good overall with a rating of Outstanding for the key question of well led.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Fair View Lodge had a well understood, positive and open culture, with a clear set of values and ethos. We saw evidence of strong leadership both within the service and the wider organisation. The service had a strong person centred focus in all areas, and a positive and supportive atmosphere. Staff understood their roles and worked well as a team to support people to achieve and have new experiences as well as manage risks. Success was celebrated and learning took place to help improve the service and people’s lives. The registered manager and management team were enthusiastic and creative in supporting people, recognising people’s potential and ensuring resources and facilities were available to support this.

Feedback we received about the service was overwhelmingly positive. Relatives for example told us “This is the best placement ever” and “When I get there, I do see the caring. It is there, it is genuine, I am thrilled with them. It’s the best place they have ever lived.” Visiting professionals told us the service provided a high standard of person centred care.

The service operated along the principles of positive behavioural support or PBS. This is a way of helping people with learning disabilities who are at risk of anxious or distressed behaviours to have the best quality of life they can. The registered manager had achieved a BTEC qualification in positive behavioural support, and the service was supported by a PBS practitioner, who was involved in writing support plans, delivering training and working with the staff teams to support people with specific issues. We saw and heard how people had been supported consistently to have new experiences, establish communication in more positive ways and build more positive relationships. A relative shared with us their experience of how their relation had progressed since being at the service, including how their world was “opening up”. Another person had recently been able to re-establish contacts with family members and have a greater involvement in the community.

Staff told us “I love it here – I’m really passionate about it” and “I love it, it’s great…I ask a lot of questions, and there is very good support from the management and the team”. Staff spoke positively about the people they were supporting. A staff member told us “I can’t wait to get in here every morning and see what we can do today, how we can keep working to give people new opportunities.”

Each person had a comprehensive care plan, based on a regularly updated assessment and positive behavioural support principles. Plans were very p

Inspection carried out on 25 November 2015

During a routine inspection

This inspection took place on the 25 November 2015. Notice of the inspection was given to the service the day before we visited. This allowed the service to prepare the people living there and to ensure that the manager who covers two residential care services was available to support the inspection.

Fair View Lodge is a care home without nursing, providing support for up to three people living with an autistic spectrum disorder. Each person had their own flat with private space. There were some shared facilities which people could use if they wish, for example an enclosed garden area.

There was not a registered manager in post. However there was a manager at the service who had made an application to be registered. This had been accepted and was being processed by the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager was already registered to manage a similar service locally and was experienced in supporting people with autism.

Since the last inspection at Fair View Lodge in 2013 there had been a number of changes of management, the most recent being in the summer of 2015. The arrival of a new management team had led to a re-focus of the service, based on principles of positive behaviour support. This meant that the service was basing their care more on person centred values, enhancing people’s involvement with the community, increasing personal skills and placing emphasis on respect for the person.

Risks to people were being assessed and actions taken to minimise them where possible, but in ways that meant people still had opportunities to develop and have new experiences. Staff understood what they needed to do to keep people safe or report concerns about potential abuse. There were enough staff on duty to support people and to carry out the activities they wanted to do. Systems were in place to manage complaints and ensure people with communication difficulties were able to raise concerns.

A full recruitment procedure was followed for staff. Not all staff had undertaken all the training they needed due to there having been a significant change in staffing. This was being managed by targeted action plans. Training was available with on line courses as well as specific areas being delivered face to face. Supervision and appraisal systems had been established to ensure staff received the support they needed. Staff felt supported and told us they had access to the training they needed.

Medicines were being managed safely and the service learned from incidents or events.

The principles of the Mental Capacity Act 2005 (MCA) were well understood and put into practice. Applications for the Deprivation of Liberty Safeguards had been made appropriately.

Fair View Lodge comprised three separate flats with some communal areas that people could use if they chose. This meant people had private space, or could choose to spend time with other people. The building had been personalised to meet the needs of the people living there, including adaptations to keep people safe. Maintenance and infection control issues had been identified and were being addressed. For example changes were scheduled to make the laundry area easier to clean and keep free from infection control risks.

We saw examples of positive and supportive care and relationships between staff and people living at the service. People were valued as individuals and there was a focus on maximising their potential. People had individual activity programmes which were followed unless the person chose otherwise. Opportunities were being explored to maximise people’s involvement in the local community. People were being supported for example to have increased independence with their meal choices and be involved more in shopping and meal preparation. Staff were enthusiastic and positive about people’s progress; they respected people’s confidentiality and celebrated successes and special events with people.

Care plans were personalised to each individual and contained sufficient detailed information to assist staff to provide care in a manner that was safe and respected people’s wishes.

Although not yet registered the manager had made significant changes to the service since being in post. There were effective systems for governance, quality assurance and ensuring safe care for people. Staff were clear about the ethos of the service and were working well as a team. Resources had been made available to support the development of the service.

The service took account of good practice guidance and people had opportunities to influence the way the home was run.

Records were well maintained, and notifications had been sent to CQC or other agencies as required by law.

We recommend the service explores ways of further supporting people with their finances through the use of advocacy services where appropriate.

Inspection carried out on 21 November 2013

During a routine inspection

We met people, talked to staff and looked at records to help us understand how people viewed this service because people were not able to explain their opinions in detail. They did, however, provide us with short responses to our questions. Because of this, we also spent time observing their body language and facial expressions.

Although people were not able to articulate their feelings clearly, they were clearly relaxed, happy and comfortable around staff. One person told us they were �happy" living at the service. Another person said �yes, yes, yes� when we asked if they were happy living here. Both people smiled when they responded.

We saw that staff treated people respectfully and encouraged each person to be as independent as possible. People were occupied in activities that they appeared to enjoy. One person went out for the morning, whilst the other person spent time preparing to go out later in the day. Staff were patient and supportive with both people.

Staff told us they received regular training and felt supported by the manager. One staff said "we know what people need and how to provide it". Another staff told us "the training is good because we tend to talk a lot and get a lot of discussions going".

All staff had received safeguarding training and demonstrated a good understanding their responsibilities in whistleblowing and preventing and reporting abuse.

The service monitored quality and looked to improve standards whenever possible.

Inspection carried out on 29 June 2012

During a routine inspection

We, the Care Quality Commission, visited Fair View Lodge on 29 June 2012.

People living there had very complex needs. This meant that it was difficult for them to tell us what they thought of the home and the care they received. We used a number of different methods to gather information about people's views and their experiences. During out visit we met with the three people living at the home. We spoke with two of them and saw one person�s private accommodation. We observed people whilst they were being supported by staff. We spoke with a relative and asked five health and social care professionals for their feedback.

We saw that staff treated people respectfully at all times, promoting their independence and choice whenever possible. Records showed when people had made important decisions, how they had been involved in making decisions, and when they had decisions made on their behalf. Records also showed that external agencies had been involved in making best interests decisions, in planning care and in reviewing that care. A relative told us they felt involved in this process and was always invited to meetings.

We found that people engaged in a variety of activities of their choosing, and that staff tried to provide opportunities for people to have new experiences.

People had their physical health care needs met through health promotion and because staff supported them to attend specialist appointments. The way that staff managed the needs of one person who had to be admitted to hospital, is being used by hospital staff as an example of best practice to be used for training purposes.

Staff were well trained and supported to meet people's individual needs and to help manage some people's behaviours which were challenging. There was a low incidence of staff intervention or restraint. Staff demonstrated a good understanding of the types of abuse and of their role in preventing and reporting abuse. They also understood how to escalate any concerns and were familiar with the whistle blowing policy.

Staff received induction, mandatory and specialist training, and regular supervision.

Systems were in place to gain feedback and to monitor the quality of services being provided. One relative said they felt they had a voice in the home. The manager was familiar with the risks associated with the type of service being provided and had systems in place to monitor and manage those risks.

Reports under our old system of regulation (including those from before CQC was created)